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The Lancet

The Lancet (click to view)

The Lancet

New antibiotics are becoming available for the first time but without accurate diagnostics, clear treatment guidelines, and improved control efforts, their effectiveness could be rapidly lost.

The rise of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) threatens to derail decades of progress in controlling the disease, according to a new report in The Lancet Respiratory Medicine published on World TB day (24th March).

Although a small number of repurposed and new drugs have recently become available to treat drug-resistant TB (including bedaquiline, delamanid, and linezolid), the authors warn that without accurate diagnostic tests to deliver individually targeted treatments, clear prescription guidelines on appropriate use and improved control efforts to prevent transmission, optimal dosing and administration, and well-functioning health care systems, the effectiveness of the drugs could be rapidly lost.

pproximately 1 in 5 cases of TB are now resistant to at least one major anti-TB drug and approximately 5% of all cases of TB are classed as MDR (resistant to two essential first-line TB drugs, isoniazid and rifampicin) or XDR (also resistant to fluoroquinolones and second-line injectable drugs). Globally in 2015, there were an estimated 480000 cases of MDR-TB, with approximately half of these cases being in India, China, and Russia. But, migration and travel mean that highly drug-resistant TB strains have emerged in almost every part of the world.

MDR and XDR-TB are associated with high mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. The mortality rate is extremely high at around 40% for patients with MDR-TB, and 60% for patients with XDR-TB. Of the US$6.3 billion available in 2014 to respond to the global TB epidemic, about a third ($1.8 billion) was for MDR-TB (despite drug resistant TB forming only 5% of the total caseload).